For Doulas, Labor is All in a Day’s Work

When Jeffrey Schmitt confronted the prospect of coaching his wife through the birth of their first child, he quickly came to a realization:

He didn’t have a clue about what was going to happen.

His wife, Gina Ciocco-Schmitt, figured out the same thing. So when she heard about the idea of hiring a “doula” — someone experienced in helping women through childbirth — she signed up for one.

“It was our first child so we were anxious about the whole thing, and we wanted someone who had been through the experience before,” Ciocco-Schmitt said.

That someone turned out to be Nancy Goldman, a certified doula who has helped dozens of women through labor and delivery with her bag of childbirth tricks.

She arrives with a large blue “birthing ball” that women can drape themselves over, to help them through the next contraction. A paint roller that she glides across the lower back. A rice-filled sock that she microwaves to bring warm, soothing relief to the lower abdomen.

And, perhaps most critical, a general sense of assurance and knowledge about what’s going to happen next.

Even though the couple had already taken childbirth classes from Goldman, the doula’s presence in the delivery room eased their anxiety.

“I thought of it as a coach-assistant coach relationship,” said Schmitt, who worked shoulder-to-shoulder with Goldman when the couple’s daughter, Kaylie, was born on Jan. 1. “She knew more about what was going on, and I knew more about my wife and what she needed.”

“I’m like their security blanket,” Goldman said.

The word “doula” is Greek for “trusted servant” or “handmaiden.” The concept goes back centuries, to sisters and aunts and mothers and servants who helped women through the arduous experience of childbirth, usually in the privacy of bedrooms.

The idea is returning in this high-tech hospital world through the natural childbirth movement. Women have become better educated about their childbirth options, more assertive in crafting “birth plans,” and, in many cases, more interested in delivering without interventions such as drugs or surgical procedures.

Doulas also can fill a niche in a military area such as Hampton Roads, because many men are out to sea when their wives go into labor.

A doula differs from a maternity nurse in that she stays with the mother throughout the delivery. She provides no medical care, but helps with different relaxation techniques, comfort measures and birthing positions. She’s also different from a first-time coach — usually a father or friend — because she knows the ropes.

“It takes the pressure off the dad,” Goldman said. “Sometimes coaches are literally dragged into the delivery room not knowing what to do, just knowing they’re expected to be there.”

The number of doulas in the United States and Canada has risen from 750 in 1995 to 3,500 this year. About 1,200 of them have been certified by Doulas of North America, according to the organization’s administrative director, Kristi Ridd-Young. DONA was founded in 1992 to give doulas support and to provide a baseline of education through certification.

The organization requires, among other things, that a doula take 14 hours of labor and support training, attend three births and undergo a written evaluation by a primary-care professional such as a doctor or nurse.

Ridd-Young said her group encourages women who hire doulas to file for insurance coverage, but companies usually don’t cover the cost, which can range from about $300 to $1,000 a delivery. Some states, such as Texas, have proposed legislation to require insurance to pay for doulas.

“When I first started here eight years ago, we’d see maybe one doula a year,” said Valerie Eichenberger, nurse manager at the Center for Birth at Bon Secours DePaul Medical Center in Norfolk. “Now we’re getting one to three a month. I think they’re here to stay.”

Because of that, hospitals are forming closer relationships with doulas.

At DePaul, for instance, 15 nurses from the Center for Birth recently were trained to be doulas by Goldman, a certified trainer, and are in the process of getting certification. Four nurses and one lactation specialist from Sentara hospitals went to a DONA workshop organized by Norfolk doula Tracy Duval in October.

Cherie Price, a lactation consultant at Sentara Virginia Beach General, said she’s becoming a certified doula in hopes of helping women who want a more natural childbirth.

Eichenberger said she not only wants the Bon Secours nurses to learn the doula techniques as a service to their clients, but also to make sure everyone knows their role in the delivery room.

“I want them to know the role of the doula inside and out, so if a doula steps outside her role, the nurse can say, ‘I’m a certified doula, too.’ ”

Center for Birth nurse Nora Miley said she was a little skeptical about the doula training. But it gave her a better understanding of doulas and taught her some techniques that she has incorporated into her work.

“The thing about a doula,” she said, “is they have an established rapport with the woman before they get here. And if that helps her through the labor, that’s great.”

Eichenberger said research has shown that doula-attended births can reduce the need for Caesarean sections and other interventions such as epidurals, anesthetic injections given to relieve pain during labor.

In line with its goal of keeping the rate of Caesarean sections low, Bon Secours is offering the services of doulas free of charge to qualified low-income women, many of whom do not have spouses or family to help them through labor and delivery. That initiative will be funded by a Bon Secours Foundation grant.

Goldman, who will be overseeing those partnerships, began her doula work informally through Lamaze childbirth classes she teaches at DePaul. She often told students to call if they needed help. One night, a woman took her up on the offer, phoning her at 2 a.m. to come help her through labor and delivery.

Goldman loved the experience and started helping other women as well. She became a certified doula five years ago.

She meets with a couple once or twice before the delivery to go over a birth plan and discuss what pain-control measures the woman wants. Most of the women want as little medical intervention as possible but reserve the right to change their mind.

Sometimes, the lotions and massages and showers and various birthing positions suggested by a doula can help a woman go further than she would otherwise in weathering labor pains.

Virginia Beach resident Stacy Shull said her experience having her first child six years ago in Colorado left her wanting something different the second time.

“I had my first at a teaching hospital in Colorado, and I felt like there were 25 strangers in the room,” she said. “I went through 30 hours of labor with mega-drugs. I didn’t feel like I had any control. I wanted it to be more natural this time.”

She met Goldman through a childbirth class at DePaul and decided to hire her to help her and her husband, Ben, through the birth of their son, Micah, who was born in July.

She’s glad she did.

“I’m not having any more children,” Shull said, “but if I did, I’d have a doula.”

News researcher Peggy Earle contributed to this report.
You may reach Elizabeth Simpson at liz@pilotonline.com
This article first appeared in the January 30, 2001 edition of the Virginian-Pilot